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Sunday, September 04, 2005

As the tragedy of New Orleans continues to unfold in front of us, I keep thinking about it from the perspective of the medical field and what could have been done to prevent some of the deaths that occured. Deaths that were, in all likelihood, unnecessary.

I'm not talking about unnecessary in regards to the actual rescue efforts, but in regards to how many individuals did not have an emergency medication supply ready to go when they needed to evacuate. Actually, a kit that should have been ready and in their hands or carrying bags the minute the Hurricane warning came, not to mention when the order to evacuate was issued. This includes oxygen patients who were without oxygen and had no evacuation plan. How many diabetics went into diabetic shock without their medication or because their medication was unrefrigerated for so long?

It's a tragedy that is both the responsibility of individual citizens and the medical profession that more (though probably not all) of these individuals could have survived if appropriate emergency preparations had been made regarding medication, supplies and oxygen tanks.

As I noted in my previous post, patients being cared for by home health agencies (including nursing and medical equipment) are generally given either a sheet or pamphlet that instructs them on appropriate emergency preparations, evacuation and what the home health agency will do in case of an emergency. This often includes instructions to listen to a specific radio station (AM) for further instructions or numbers to call (this obviously would have failed in NO due to the disaster of the infrastructure, but there is usually back up). These agencies also usually keep an emergency list with one or more people who take it home so that they can inform emergency personnel about their patients that might need immediate rescue and to try to contact that patient as soon as communications allow.

The patients that don't get this kind of instructions are "outpatients" who are simply seen at a doctors office and collect their medication at the pharmacy. Here is where the medical and pharmacy professionals may need to re-assess their roll in caring for their patients beyond the office and pharmacy counter. These patients are often on maintenance drugs for blood pressure, diabetes, cancer and other diseases that may become life threatening if maintenance medications are not taken. I believe that the medical profession should take a more active roll in providing information for emergency preparations and enforcing those instructions more clearly.

I am also aware of the amount of time that home health agencies spend on explaining the emergency preparation information with their patients. It's about two seconds: "And this is the emergency preparedness brochure that you should read."

Generally, this lack of emphasis is because these patients are generally mobile and that, beyond a few instances, the medical profession bares no legal responsibility for these patients in an emergency situation.

The reality is, we need to be more pro-active as individuals, family, care givers and neighbors in preparing medically compromised patients for emergencies.

In the extended version of this post, under "read more" you will find basic instructions for preparing for an emergency if you are on maintenance medications (blood pressure, nitrogen, cholesterol, pain, cancer, etc) or on medical equipment like oxygen or nebulizer (breathing treatments). If you are not personally on either of these, you should pass this information to your family, friend or neighbor that is and ask them to follow this plan. You should make an effort to help them prepare.

Emergency Preparedness and Your Medicine

I. Medications

A. Medications that do not require refrigeration

1) Keep your prescriptions filled

a. Your physician usually gives you a prescription for the entire treatment or for at least 30 days.

i. Some medications may even be “filled” for 60 or 90 days in advance. Check with your physician and pharmacist.

2) Do not let your medication run out.

a. If the prescription is a “maintenance” drug or something that you take routinely, the prescription can be refilled several days in advance of the current prescription running out.b. Mark on your calendar the day that the medication will run out.c. Mark on your calendar at least 3 or 5 days in advance of the prescription running out to call for a refilld. Make sure you pick up that refill within 24 hours.

i. This will ensure that you always have at least 3 to 5 days worth of medication available at all times (if not a months worth)

3) Keep samples as “extra”

a. If a physician gives you a prescription AND he gives you samples to take home, fill the prescription immediately.b. Do not take the samplesc. Put them with your “emergency medications” (directions for “emergency kit” to follow)

i. This will also ensure that you have several days or weeks worth of medication available in case of an emergency

4) Prepare an Emergency Medication Kit

a. Keep a set of “empty” medication bottles with their labels still intact.

i. In each bottle, place 5 to 30 days of each medication in the correctly labeled bottle.ii. Make sure you check the medications against the labels

b. In a plastic, clear, Ziploc (preferably water proof) bag:

i. Place your extra medicationsii. An equal amount of needles and syringes (if required) to the number of doses placed in the bagiii. Alcohol or iodine swabs (if required)iv. Extra: a collapsible cup to hold water

c. Replace “extra” medications in your emergency kit routinely as you refill your prescriptions with the most recent medication

i. Most medications have expiration dates. Make sure the emergency kit has the most current medication.

d. Place this kit in a secure location that is easy to remember and to access.

i. Refrigerators are a good place to keep your emergency kit. They are heavy, have doors and can be located easily in the house (even if your medications do not require refrigeration).ii. Other areas include cabinets or drawers that are above three feet from the ground (in case of flooding), but are not so high that you have to climb on anything to retrieve it; or with your personal “emergency preparedness kit” including food, water and first aid; or in your purse or personal carrying bag.iii. People in wheelchairs should keep the medication in an easily reached location.

e. Make sure that your “kit” is clearly marked “emergency medication”

i. This can be a label on the outside or a piece of paper with the information inside the bag.

f. Tell your family, friends or caregivers where this kit is in case you must exit the house quickly.

5) Keep a copy of each of your prescriptions OR take a label off of an empty bottle of each of your medications.

a. Labels can be removed by soaking them for several minutes in warm soapy water.

i. Make sure that they dry completely and are readable.ii. Some pharmacies provide “inserts” or information sheets with the medication with a label attached to it with the name and directions for taking the medication. This can be used as well.

b. Place the copies of your prescriptions, the labels or inserts in your wallet or purse or other “carry” item that can be easily located and that you would normally carry with you when you leave the home

i. Keeping it your “carry” item (wallet or purse) will ensure this is available if your emergency evacuation is to a hospital or other medical care unit and you are unable to retrieve your emergency medication kitii. Medical emergency personnel often look for a purse or wallet for information about the person being transported

c. This will ensure that when you arrive at a location where medications can be dispensed, your information is available and your prescriptions can be filled without delay.

B. Medications that require refrigeration.

1) Follow the basic guidelines noted for non-refrigerated medications

a. Keep your prescriptions filledb. Fill the prescriptions as far in advance as possiblec. Write the information on a calendar or other place that will remind you to keep them filled.d. Keep extra medications in your “emergency preparedness kit” along with necessary items like syringes, needles, alcohol swabs, etc.

i. Everything necessary to administer your medication for the same number of doses contained in the kitii. Keep extra alcohol swabs to sterilize needles if it becomes necessary to re-use them.

e. Place medications and supplies in a clear, Ziploc bag.d. Replace “extra” medications in your emergency kit routinely as you refill your prescriptions with the most recent medication

i. Most medications have expiration dates. Make sure the emergency kit has the most current medication

a. Most electric medical equipment will operate on a back up battery for several hours.

i. Some as many as 24 hours (see equipment information insert for details or ask your medical professional)ii. Some have rechargeable batteries

b. Check the equipment or manufacturer insert for the necessary battery size.c. Keep at least two batteries per piece of equipment in your emergency medication kit or in a Ziploc bag attached to your equipment.d. Keep rechargeable battery packs fully charged at all times.

i. Use electrical outlets if possible instead of your batteries to keep the battery fully charged in case you must switch to battery power

B. Oxygen

1) Keep 3 to 5 days of portable oxygen tanks in your home or liquid oxygen in the main reservoir

a. Oxygen tank use will depend on the patient’s prescription (e.g. 2 lpm - liters per minute) and the size of the tank (e.g. 22 cubic ft).

i. Most oxygen providers for the home will provide a table that shows the amount of oxygen and how long it will last based on amount of use (e.g. 2lpm)ii. Most providers will deliver a week or more of oxygen

2) Keep the oxygen tanks in a secure location, away from electrical or natural gas or other flammable materials that may catch fire in an emergency situation.

a. Keep the tanks where they are easily foundb. Keep the tanks where they are most likely not to be covered in debris

3) Keep extra batteries for both the portable regulator and stationary concentrator

a. Most portable tanks operate using a battery operated regulator

i. Battery operated regulators will run for up to three days on one battery (if 9V) or two (if AA).

b. Most stationary oxygen concentrators will operate on a battery for several hours as well (read insert)

4) Keep an extra cannula, tubing. an oxygen wrench (for turning on the portable tank) and directions on how to use the oxygen equipment.

a. Directions for use of oxygen equipment should be available so if you or your caregiver are not able to operate the equipment and you need to seek assistance from an untrained person, they have a point of reference for setting up equipment.

5) Keep extra batteries, supplies and directions in a Ziploc bag attached to the concentrator or in a secure place

a. With your emergency medication kit if the space allows.

6) Make sure family, friends or caregiver know how to operate the equipment, replace the batteries and where the emergency supplies are.7) Keep a copy of your prescription or other oxygen orders in your purse, wallet or emergency medication/supply kit for easy access.8) Keep the number of your oxygen supply company in your wallet, purse or emergency medication/supply kit.

a. Oxygen supply companies usually have emergency plans for delivering more oxygen to their patientsb. If you are able to stay in your home, they will deliver there if they are able.c. If you must evacuate to a different location or station, they will deliver to you there or they will arrange for another company near by to provide oxygen

9) If you must evacuate immediately to a different shelter, take as many tanks as can be carried along with the emergency medication and supply kit.

a. Some shelters may not allow more than one or two tanks as they present a real danger if they become flying debris. Check with your local shelter for details.b. Take the concentrator if possible

i. Some shelters may have electricity or gasoline generators electricity that can sustain the concentrator.ii. Concentrators do not require separate oxygen tanks to create oxygen. Concentrators create/deliver oxygen using a mechanical compressor and filtering system.iii. Use the concentrator as long as possible. This will keep the portable tanks ready when there is no more electricity.

1) Do not wait for an emergency to occur to prepare the emergency medication and supply kit

a. The kit should be prepared and standing by for pick up if you must leave or seek shelter immediately

2) If you are on oxygen or other mechanical medical equipment that requires electricity and is life sustaining, you should call your local fire department or EMS to insure that your name is on a list of people that need to be rescued or evacuated first.3) If you are on oxygen, other mechanical medical equipment that requires electricity OR medications that require refrigeration, call the electrical, gas and phone company and tell them that you are on oxygen or other life sustaining medications or machines. They will put you on a priority customer list for restoration of services

a. Many of these companies will make arrangements to insure that your services are never disconnected if you are unable to pay.

B. Prepare an evacuation plan

1) Organize a plan with family, friends or caregivers to evacuate the residence when an emergency occurs

a. Make a plan with family, friends, and neighbors to check on youb. Make a plan for someone to come and get you if you are unable to drivec. Make a plan with neighbors to check on you and assist with evacuation if you have no friends or family near by to assist or cannot evacuate yourself.

2) Know where local shelters are located3) Plan on a place to meet family or friends after the emergency clears4) Keep a list of phone numbers to call after emergency clears

a. Get cell phone numbers and pager numbers

5) In case local phone lines or cell phone towers are no longer working in the area or you are unable to meet at the designated location, have the name and number of a central person that you and your family will call to let them know where you are and how they can contact you.

C. When Warning Comes

1) Heed warnings to seek shelter or evacuate as soon as they are given.2) Do not wait for an evacuation or “seek shelter” order to be given to retrieve your emergency supplies, have them ready as soon as local news, weather channels or national emergency channels tell you that a storm is on the way or some other emergency is occurring.3) Take your medication emergency kit or extra tanks with you to the shelter, whether that is an outside location or in your home.

D. Sheltering in your home

1) If an emergency or disaster occurs and you do not need to leave your house, or you cannot leave your house and the electricity goes out:

a. Keep your emergency kit in the refrigerator.b. Do not open the doors unless you have to for either the refrigerator or freezerc. Put the medications in the freezer as soon as the refrigerator seems to be room temperature.

i. Even refrigerated medication can survive at room temperature for a short period of time. Keep the freezer shut and cool until absolutely necessary to open the doors and put your medication in.ii. If possible, put your medication in the cooler or other container with your ice packs and put the cooler in the freezer. This will keep them longer.

d. Use your oxygen tanks conservatively.

i. Use your concentrator or stationary oxygen system for as long as the battery will allowii. Only change to tanks when the stationary system is no longer availableiii. Conserve your oxygen by remaining calm.iv. Stay immobile, sitting down or lying down as much as possible (unless you must evacuate or once you arrive at shelter).v. Staying calm and sitting down will keep the oxygen use down to a minimum.

This is a lesson we should all learn as I watch the news this morning, many patients that have made it through, are now at a shelter, do not have their medicine with them, do not remember what their medication is and health care workers are desparately trying to get them what they need.